hDepartment of Health Sciences and Clinical Evaluation, University of York

Editor-Some of the recommendations in Maynard and Bloor's editorial on regulating the pharmaceutical industry are reminiscent of the days when the government was generally believed to be the best arbiter of how industry should invest its resources.1

The authors’ faith in the use of cost effectiveness analysis as a rationing mechanism is perhaps not surprising in view of their professional background. But to our knowledge there is no evidence-for example, from the Australian authorities-that the use of such analysis as a rationing mechanism improves public health. Indeed, some people have argued that it does exactly the opposite. It limits access to new interventions and protects established therapeutic regimens, which are never subjected to the same level of rigorous analysis.

Moreover, what research there has been suggests that the general public does not support the utilitarian value system inherent in cost effectiveness analyses.2 A rationing system that allocates resources on the basis of probable outcome rather than need does not seem to sit comfortably with current social values. Furthermore, cost effectiveness varies on a patient by patient basis. A system that blocks access to new treatments for the whole population is not reasonable when there are some patients for whom such an intervention is indeed very cost effective.

In a system constrained by costs, economic efficiency should naturally inform decisions on allocation of resources, but not as a blunt instrument of regulation for limiting access across the whole population. Rather, this is part of the general market in information that will allow healthcare professionals to make sensible decisions on how they treat individual patients.

The authors’ final suggestion is that there should be government direction of industry's expenditure on research. Financial penalties would siphon funds which could be directed at universities and the Medical Research Council. Again, where is …